Orange County NC Website
DocuSign Envelope ID: B08FAD4E-2A8A-48ED-BD61-AOC9AD497C13 <br /> CLEAN-1 OP ID:JD <br /> ,4CUR0" CERTIFICATE OF LIABILITY INSURANCE <br /> DATE <br /> 09/03120151) <br /> 09/03/2015 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Sentinel Risk Advisors NAME: Johnette Dent <br /> 4700 Six Forks Road#200 aic°No Ext:919-92611623 �AAic,No ): 919-92611664 <br /> Raleigh, NC 27609 a DRESS :jdent@sentinelra.com <br /> Michael Story <br /> INSURER(S)AFFORDING COVERAGE NAIC <br /> INSURERA:AMCO Insurance Company 19100 <br /> INSURED Clean Design Inc INSURERB:United States Liability,Ins.CO 25895 <br /> 8081 Arco Corporate Dr#100 <br /> Raleigh, INC 27709 INSURERC: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS <br /> LTR POLICYNUMBER MMIDD MM1DD <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> CLAIMS-MADE �OCCUR CPBP03007084777 03/26/2015 03/26/2016 PREMISES(Ea occurrence)PREMISES Ea occurrence) $ 300,000 <br /> MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 <br /> POLICY PE° LOC PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) $ 1,000,00 <br /> A ANY AUTO ACPBP03007084777 03/2612015 03/26/2016 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> X HIRED AUTOS X AUTOS NED (Per a.d nt)AMAGE $ <br /> X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,00 <br /> A EXCESS LIAR CLAIMS-MADE ACPCAA3007084777 0312612015 03/2612016 AGGREGATE $ 2,000,00 <br /> DED I I RETENTION $ <br /> WORKERS COMPENSATION PER OTIi- <br /> AND EMPLOYERS'LIABILITY Y f N STATUTE ER <br /> ANY PROPRIETORJPARTNERIEXECUTVE E.L.EACH ACCIDENT $ <br /> OFFICER(MEMBER EXCLUDED? � N/A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> f yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ <br /> B Professional Liab SP1559388 04/13/2015 04/13/2016 Each Clai 1,000,00 <br /> Errors&Omissions Aggregate 1,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> CHAP501 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Chapel Hill/Orange a Coun THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> p g County ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Visitors Bureau <br /> 501 W. Franklin Street AUTHORIZED REPRESENTATIVE <br /> Chapel Hill, NC 27516 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />